Summary & Overview
CPT 0270U: Versiti Coagulation Disorder Panel, NGS 20-Gene Test
CPT code 0270U designates a Proprietary Laboratory Analyses (PLA) test for the Versiti™ Coagulation Disorder Panel, a next-generation sequencing (NGS) assay of 20 genes linked to heritable coagulation disorders. The code matters nationally as precision genetic diagnostics expand clinical pathways for diagnosing bleeding disorders, informing family risk assessment, and guiding specialist evaluation. PLA codes like 0270U are specific to a single manufacturer's test and therefore have particular implications for coverage policy, billing transparency, and lab reporting.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the panel, the service setting and specimen types, and what payers commonly review when adjudicating claims for PLA genetic tests. The publication also summarizes typical benchmarks and policy considerations relevant to PLA coding, explains common billing modifiers used with laboratory services, and highlights areas where coverage language and prior authorization practices can affect access. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 0270U is a Proprietary Laboratory Analyses (PLA) code for the Versiti™ Coagulation Disorder Panel performed by Versiti™ Diagnostic Laboratories. The test uses next-generation sequencing (NGS) analysis of 20 genes associated with heritable coagulation disorders, including von Willebrand disease and hemophilia A and B, to assist clinicians in differential diagnosis for symptomatic patients and in evaluating familial risk for inherited bleeding conditions.
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Service type: Genetic diagnostic testing using NGS for heritable coagulation disorders
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Typical site of service: Clinical diagnostic laboratory; specimen types include blood, buccal swab, or amniotic fluid
Clinical & Coding Specifications
Clinical Context
A 28-year-old woman with a lifelong history of mucocutaneous bleeding and a positive family history of bleeding disorders is referred to a hematology clinic for diagnostic evaluation. After initial laboratory testing (CBC, PT/INR, aPTT, von Willebrand factor antigen/activity, and platelet function studies) returns inconclusive for a specific bleeding disorder, the hematologist orders the Versiti™ Coagulation Disorder Panel (0270U) to perform next-generation sequencing of 20 genes associated with heritable coagulation disorders. Specimen collection is typically a peripheral blood draw; alternative specimens such as a buccal swab or amniotic fluid may be used for family cascade testing or prenatal evaluation. The laboratory performs targeted NGS analysis and reports pathogenic, likely pathogenic, and variants of uncertain significance to aid in differential diagnosis, carrier status determination, and familial risk counseling. Typical sites of service include an outpatient hematology clinic for ordering and specimen collection and a certified clinical molecular diagnostics laboratory (Versiti™ Diagnostic Laboratories) for testing and reporting. Clinical workflow: patient evaluation and informed consent → specimen collection (blood, buccal swab, or amniotic fluid) → shipment to the performing laboratory → NGS analysis of the 20-gene panel → laboratory report with variant classification sent to ordering provider → follow-up visit for result interpretation and family risk discussion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no additional modifier applies. |
22 | Increased procedural services | Rarely used; apply only if unusually complex preanalytic procedures increased laboratory work beyond standard. |
26 | Professional component | Use when reporting only the professional component (interpretation) separate from the technical component, if applicable and the lab separates components. |
52 | Reduced services | Use if the laboratory performed a reduced version of the test or partial analysis. |
53 | Discontinued procedure | Use if testing was started but discontinued for valid clinical or technical reasons. |
62 | Two surgeons | Not typically applicable to lab testing; limited use when two providers share professional responsibility for interpretation. |
78 | Unplanned return to operating/procedure room by same physician following initial procedure | Not applicable to this lab test; include only if procedural re-entry occurred during an associated invasive procedure. |
80 | Assistant surgeon | Not applicable to the lab test; may be used for associated procedures requiring surgical assistance. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when a qualified nonphysician practitioner performs collection or coordinates testing and billing rules allow. |
TC | Technical component | Use when reporting only the technical component (laboratory processing and sequencing) separate from professional interpretation. |
QX | Ordering physician is also performing/servicing lab under CLIA? | Use per payer rules when reporting services involving laboratory personnel billing distinctions (apply only per payer guidelines). |
QY | Qualified nonphysician laboratory personnel | Use when qualified nonphysician personnel perform the service under supervision per payer rules. |
SH | Physician certifying and managing care of a patient receiving home health services | Use if specimen collection occurred in the home health setting and billing requires this modifier. |
TG | Services furnished under a grant-funded program | Use when the test is provided under a grant that affects billing status. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Hematology | Ordering and clinical interpretation specialists for coagulation disorders. |
| 2080P0207X | Clinical Genetics | Geneticists and genetic counselors involved in germline variant interpretation and family risk assessment. |
| 207L00000X | Pathology | Molecular pathology specialists overseeing NGS test validation and result interpretation. |
| 207LP2900X | Laboratory Director | Clinical laboratory directors responsible for CLIA-compliant test oversight. |
| 363LF0000X | Phlebotomy | Personnel who perform specimen collection in outpatient or inpatient settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D68.4 | von Willebrand disease | Primary hereditary bleeding disorder assessed by the 20-gene coagulation panel. |
D66 | Hereditary factor VIII deficiency (Hemophilia A) | Gene variants in F8 are targeted by the panel for diagnosis and carrier detection. |
D67 | Hereditary factor IX deficiency (Hemophilia B) | Panel includes genes relevant to hemophilia B evaluation. |
D69.3 | Immune thrombocytopenic purpura | Included as differential diagnosis; genetic panel may help exclude inherited causes when thrombocytopenia is suspected hereditary. |
R58 | Hemorrhage, not elsewhere classified | Used when patients present with significant bleeding of unclear etiology prompting genetic evaluation. |
Z15.01 | Genetic susceptibility to malignant neoplasm of breast | Example of genetic predisposition coding conventions; not specific to coagulation but illustrates familial risk coding practices. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
80048 | Basic metabolic panel | Common baseline laboratory tests performed during initial evaluation of a bleeding patient. |
85025 | Complete blood count (CBC) with automated differential | Routine hematology test performed before or alongside genetic testing to assess for cytopenias or other abnormalities. |
85610 | Prothrombin time; international normalized ratio (INR) | Key coagulation screen that often precedes targeted genetic testing for bleeding disorders. |
85730 | Thrombin clotting time or fibrinogen assay | Performed as part of coagulation workup to characterize bleeding phenotype. |
81225 | Variegated — Hemophilia A (F8) gene analysis (example single gene) | Single-gene testing that may be ordered when suspicion is high for a specific disorder; the panel (0270U) offers broader NGS-based analysis. |
81479 | Unlisted molecular pathology procedure | Used for reporting additional custom or unlisted molecular tests that may accompany panel testing when no specific CPT exists. |